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The Effect of Leucine-Enriched β-Lactoglobulin Versus an Isonitrogenous Whey Protein Isolate on Skeletal Muscle Protein Anabolism in Young Healthy Males.
Full text linkBACKGROUND: β-lactoglobulin (BLG) is a protein found within whey protein (WP) that is rich in essential amino acids, most notably, leucine (LEU). LEU is considered the most potent EAA in the postprandial stimulation of muscle protein synthesis (MPS), such that suboptimal protein/essential amino acid (EAA) doses containing higher LEU content elicit muscle anabolism comparable to larger protein doses. Our objective was to test the effects of naturally LEU-rich BLG (~10 g protein) versus isonitrogenous whey protein isolate (WPI, ~10 g) on MPS. METHODS: Ten healthy young men (26 ± 2 y; 179 ± 2 cm; 81 ± 3 kg) received BLG (1.57 g LEU) or WPI (1.02 g LEU) in a randomised double-blind cross-over fashion. A primed constant intravenous infusion of [1,2 13C2] LEU was used to determine MPS (isotope ratio mass spectrometry) at baseline and in response to feeding (FED) and feeding-plus-exercise (FED-EX; 6 × 8 unilateral leg extensions; 75% 1-RM). Plasma insulin and EAA's were quantified. RESULTS: Plasma EAA, branched-chain amino acid (BCAA), and LEU concentrations increased rapidly following both protein supplements but exhibited a significantly greater EAA/BCAA/leucinemia following BLG (p < 0.05 for all). MPS increased significantly in both FED (~52%) and FED-EX (~58%) states, with no significant differences between supplements. CONCLUSIONS: Both BLG and WPI effectively stimulated MPS doses in young healthy males, with BLG offering an advantage in EAA/BCAA/LEU bioavailability. It follows that future research should explore the potential of BLG in populations exhibiting anabolic resistance and exercise anabolism deficiency, such as older adults as well as frail and clinical populations, to assess its utility in preserving muscle mass under conditions of suboptimal protein intake
Investigating adherence to the 2022 NICE vitamin D management guidelines on MHSOP (Mental Health Services for Older People) wards
No full textAims: Vitamin D deficiency is a widespread problem in older people with reduced ability for production, along with risk factors such as indoor living. Improving adherence to the vitamin D guidelines is a simple and cost-effective method of potentially reducing falls, morbidity and mortality in older patients with risk factors. Aim is to assess whether vitamin D deficiency is identified and managed appropriately according to the 2022 NICE vitamin D guidelines. Standard: 1. All patients to have vitamin D level tested on admission. 2. All patients with vitamin D level of 50 and below to be prescribed vitamin D as per guidelines. 3. If calcium deficiency co-exists with vitamin D deficiency, patients to be prescribed replacements for both as per guidelines. 4. All patients to be referred for specialist services if vitamin D deficiency presents with the following: eGFR <30, hypercalcaemia, or granulomatous conditions. Method(s): The audit was registered with the Trust following discussion with the ward managers and consultants. All inpatients on two MHSOP wards on the day of data collection were included. Using an audit questionnaire, retrospective data was collected from electronic patient notes, paper drug charts and electronic blood reporting system. Data was analysed on Excel. The re-audit occurred six months later following intervention. Interventions following the initial audit involved designing a vitamin D awareness poster for the wards, meetings with the ward pharmacist and presentation at the local MHSOP clinical effectiveness meeting to raise awareness. Result(s): First cycle: 34 patients were included. 30 out of 34 (88%) patients had their vitamin D levels tested on admission or had a recent level. Out of the 30 patients who had recent vitamin D levels on record, 15 patients had adequate vitamin D levels, seven had insufficient levels, and eight had deficient levels. Out of the 15 patients who had insufficient or deficient levels, nine patients (60%) were prescribed vitamin D. One patient who required specialist services did not get referred. Second cycle: 33 patients were included. 31 patients out of 33 (94%) had vitamin D testing on admission. Out of the 31 patients, 12 patients had deficient or insufficient vitamin D levels requiring prescription. Nine out of these 12 patients (75%) were prescribed vitamin D. Conclusion(s): Following simple interventions to raise awareness, the re-audit results showed improvements in vitamin D testing on admission as well as improved management. Ongoing communication with pharmacists and rotating resident doctors is required to sustain awareness and improve adherence.https://www.cambridge.org/core/journals/bjpsych-open/article/investigating-adherence-to-the-2022-nice-vitamin-d-management-guidelines-on-mhsop-mental-health-services-for-older-people-wards/CE17D2B16A74079729924F22F60A181
Establishing real world quality standards for domiciliary non-invasive ventilation.
Full text linkIntroduction Chronic Obstructive Pulmonary Disease (COPD) places a significant burden on healthcare. Non-invasive ventilation (NIV) is an established treatment for acute respiratory failure in COPD, with comprehensive guidelines.1 However, evidence for its use in the domiciliary setting is more recent, with no standardised criteria for initiating or monitoring treatment. Trials such as HOT-HMV2 demonstrated clinical benefit but excluded patients with BMI >35 or obstructive sleep apnoea (OSA), highlighting limited real-world applicability. We hypothesised that testing local standards in real-world COPD populations could offer insight into realistic expectations for national domiciliary NIV services. Objectives We developed local criteria for domiciliary NIV initiation and follow-up, assessing their feasibility in routine care to inform service design. We also characterised our COPD population to evaluate how well existing research2 applies to real-world patients. Methods This retrospective observational study used cross-sectional and longitudinal data from 181 COPD patients initiated on domiciliary NIV between 1st July 2021 and 1st July 2024 within an NHS trust. Seven local standards (table 1) were defined using clinical reasoning alongside available guidelines. Demographics were evaluated at initiation. Patients with ≥12 months of follow-up (n=107) were assessed for hospital readmission, comparing admissions in the year before and after NIV initiation. Results Demographics: 62% female, mean BMI 34 (n=138), 48% BMI >35. 35% had OSA, 67% ≥1 additional respiratory diagnoses. Performance against quality standards was variable (see table 1). However, there was a 33% reduction in hospital admissions among patients with ≥12 months follow-up, and 81% attended ≥3 respiratory clinics in the first year on treatment. Conclusions This study trialled proposed quality standards and examined the real-world COPD population. Our findings show that trial populations do not reflect real-world COPD cohorts, limiting research generalisability. Many standards proved overly ambitious, highlighting the need for evidence-based, achievable national guidelines. These findings support the need for a national audit to inform realistic, standardised domiciliary NIV pathways.https://thorax.bmj.com/content/thoraxjnl/80/Suppl_2/A68.2.full.pd
Alpha-Stim AID Cranial Electrotherapy Stimulation (CES) for anxiety in chronic breathlessness: a qualitative exploration of feasibility, usability, and acceptability
No full textBackground: Anxiety is common in people living with chronic breathlessness. Cranial Electrotherapy Stimulation (CES) with the Alpha-Stim Anxiety, Insomnia, Depression (AID) has evidence of effectiveness in the treatment of anxiety disorders, but little is known about its feasibility, usability, and acceptability for people living with anxiety associated with chronic breathlessness. Aim: To explore individuals’ experiences of using Alpha-Stim AID to manage their anxiety associated with their breathlessness. Methods: Participants were recruited from two hospices, with advanced chronic respiratory disease and breathlessness and anxiety, and followed either a Set Dose Regime (SDR) or a Personalised Dose Regime (PDR). Semi-structured interview with 15 participants who had used Alpha-Stim AID (SDR and/or PDR) daily for eight weeks were analysed thematically using the predefined domains of feasibility, usability, and acceptability. Results: Feasibility: the Alpha-Stim AID was readily integrated into daily routines, providing a valued hour of calmness and fostering adherence to Alpha-Stim AID use. Usability: most participants reported benefits including reduced anxiety, improved mood, better sleep, and subtle mindset shifts such as cognitive reframing, although a minority reported limited impact. Acceptability: The device was perceived as simple to use and intuitive and associated with no or mild transient side effects, with PDR enhancing comfort, perceived control, and engagement. Conclusions: Alpha-Stim AID is a low-burden, well-tolerated adjunctive intervention for anxiety in people with breathlessness, with potential benefits extending beyond symptom relief. Future research should explore long-term effects, the mechanisms underpinning mindset change, and strategies for optimisingpersonalizing dosing regimens.https://www.scirp.org/journal/paperinformation?paperid=14699
Transcranial Direct Current Stimulation (tDCS) used at home for people with self-reported depression: impact on self-reported concentration problems
No full textBackground: There is a high prevalence of concentration and cognitive functioning problems in people with depression. Research evidence indicates that transcranial direct current stimulation (tDCS) can improve cognitive functioning, and an aspect of cognitive functioning is the ability to concentrate. Flow FL-100 is a tDCS device self-administered at home. Purpose/Aim: To investigate the impact of 1, 2, 3, 6 and 10 weeks of Flow Neuroscience AB FL-100 tDCS use on self-reported concentration problems in people with depression, using the Montgomery-Åsberg Depression Rating Scale Self (MADRS-S) concentration problem question. Methods: A retrospective analysis of MADRS-S self-report data collected between 2020 and 2024. Results: Out of 20197 tDCS users with self-reported depression at baseline, 10,888 had concentration problems (53.9%). Among those who adhered to the tDCS protocol, the proportion who moved from having concentration problems to not having them was 29.3% at one week, 37% at two weeks, 45.2% at three weeks, 54.7% at six weeks, and 57.4% at ten weeks. Concentration problems strongly correlate with depression. Conclusion: The results show that tDCS can reduce concentration problems in those with self-reported depression. Some people experience concentration problems despite addressing lifestyle and environmental factors that can negatively affect concentration. There are negative side effects of some methods of improving concentration, for example, the use of stimulants. tDCS could be a valuable alternative approach to reducing concentration problems in people experiencing depression. Appropriately designed and powered randomised controlled trials (RCTs) are warranted to investigate the impact of tDCS on cognitive functioning and concentration.https://www.scirp.org/journal/paperinformation?paperid=14800
Pedicled flaps versus free radial forearm flap for phalloplasty in female to male gender-confirming surgery: a systematic review
No full textBackground: The field of gender-affirming surgery is rapidly evolving, with plastic surgery units worldwide increasingly offering these services. Phalloplasty is a critical component of female-to-male (FTM) transition, providing significant psychological and functional benefits. Although robust comparative trials are scarce, expert consensus favors the radial forearm free flap (RFF) when feasible. This systematic review directly compares outcomes of pedicle anterolateral flap (pALT) and the RFF in FTM gender-affirming surgery. Methods: A systematic review was conducted following the PRISMA guidelines, searching PubMed/Medline, Scopus, Web of Science, ProQuest, and EBSCO for eligible studies. Two independent reviewers screened and selected studies, resolving discrepancies by consensus. Flap survival and patient satisfaction were the primary outcome measures. Secondary outcomes included standing voiding ability, penetrative sexual function, number of operative stages, surgical duration, anesthetic techniques, and donor site morbidity or acceptance. Risk of bias was assessed using ROBINS-I, and evidence quality was evaluated using GRADE. Results: A total of 19 studies comprising 769 patients (614 RFF, 155 pALT) were included. Both techniques demonstrated comparable outcomes, although the ALT required significantly less operative time (RFF vs pALT, 290 vs 516 minutes). Flap failure rates were low for both groups (1.9% RFF, 0.6% pALT; P = 0.348), and patient satisfaction was high (78% RFF vs 76.2% pALT; P = 1.0). Risk of bias assessment indicated serious selection bias due to the observational nature of studies. GRADE evaluation rated the evidence as low, reflecting the absence of randomized trials in this field. Conclusions: The RFF remains the most reliable technique for phalloplasty, with the pALT serving as a secondary option when the RFF is not feasible. However, the limited number of studies and the lack of standardized outcome reporting in gender-affirming surgery make it difficult to draw definitive conclusions or establish evidence-based recommendations. Although both flap types are considered safe for female-to-male phalloplasty, the small patient cohorts and absence of randomized data contribute to the ongoing uncertainty in determining the optimal approach.https://journals.lww.com/annalsplasticsurgery/abstract/2025/12000/pedicled_flaps_versus_free_radial_forearm_flap_for.11.asp
“All that I've been through has made me who I am” : youth conceptualisations of personal recovery in mental health
Full text linkÓ 2025 The Author(s). Child and Adolescent Mental Health published by John Wiley & Sons Ltd on behalf of Association for Child andAdolescent Mental Health.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits useand distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.Background Youth is a transitional period from 15 to 24 years involving developmental milestones that may be adversely affected by mental health (MH) concerns. Clinical interventions tend to focus on the reduction or cure of illness-based psychiatric symptoms. However, national and international mental policy focuses on promoting well-being and self-management through personal recovery. The leading framework of personal recovery in adults is CHIME, an acronym used to denote five key processes – Connectedness, Hope, Identity, Meaning and Empowerment. The extent to which CHIME reflects the experience of personal recovery in youth is under-researched, yet the framework often underpins youth mental health services. Method The present study uses a qualitative methodology to analyse interviews with 16 youth referred for treatment. Interviews focused on the lived experiences of youth recovery and its alignment with the CHIME processes and were analysed using a hybrid inductive and deductive reflexive thematic analysis. Results The CHIME framework was relevant to youth recovery in two ways: restoring what was perceived to be lost (restorative processes) and encouraging resilience (resilience processes). Adaptations to the CHIME framework for youth included an increased emphasis on the role of family and friends, support for grieving processes and support for identity formation during the recovery journey. Conclusion An adapted CHIME framework for youth can underpin targeted recovery-oriented care to support youth in moving towards emerging adulthood successfully while managing mental health concerns.https://acamh.onlinelibrary.wiley.com/doi/abs/10.1111/camh.7004
Microbiological profiles of infectious corneal ulcers in Derbyshire and North Nottinghamshire-a 10-year analysis.
No full textPurpose: To assess the spectrum of organisms causing microbial keratitis and their in-vitro anti-microbial sensitivities out of 2 hospitals in the East Midlands Region of the United Kingdom. Methods: A retrospective review was undertaken of all patients who underwent corneal scrapes for infectious keratitis between 2011 and 2021 at Royal Derby Hospital (RDH) in Derby and between 2009 and 2021 at King's Mill Hospital in Mansfield. Results: In total, the results of 645 corneal scrapes (from 622 patients) were analysed after exclusions. Of these, 307 (47.6%) yielded positive cultures. The mean patient age was 52.6 ± 22.1 years (Mean ± St Dev) across both sites and 332 (51.4%) were from female patients. At RDH, there were 195 positive corneal scrape cultures, from which 250 species of organisms were isolated. At RDH, 64% (160/250) were Gram-positive bacteria, 32% (81/250) were Gram-negative bacteria, 2.4% (6/250) were Acanthamoeba species and 1.2% were fungi (3/250). At KMH, there were 112 positive cultures, from which 128 species of organisms were isolated. 14 corneal scrapes from KMH were polymicrobial. At KMH, 96% (123/128) were bacterial (51% Gram positive, 45% Gram negative), 3/128 (2.3%) were fungi and 2/128 (1.6%) were Acanthamoeba. Sensitivity testing confirmed that the fluoroquinolone class of antibiotics appeared to be effective against the majority isolates across the two hospital sites. Conclusion: There are differences in microbiological profiles between these neighbouring hospitals covering neighbouring populations. Despite these differences, reassuringly, the current first-line fluoroquinolone monotherapy treatment is an appropriate first-line treatment for both hospital sites.https://link.springer.com/article/10.1007/s10792-025-03432-
Mental health services for serious mental illness: Scoping review of randomised controlled trials
Full text linkThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is
properly cited.
© 2025 The Author(s). Nursing Open published by John Wiley & Sons LtdAIMS: This review aims to classify the evidence from randomised controlled trials (RCTs) on mental health services (MHS) for people with serious mental illness (SMI) available in the Cochrane Schizophrenia Group's (CSzG) specialised register. DESIGN: Scoping review. METHODS: We retrieved and screened RCTs of service-level interventions considering non-pharmacological approaches for mental healthcare of the CSzG register. We classified and collected the main characteristics of the RCTs using a customised data extraction and charting form based on DESDE-LTS classification. RESULTS: We included 233 out of 262 total trial registries. Most of the studies were conducted in China, 136 (58%), 57 (24%) North America and 26 (11%) Europe. We classified the studies as ambulatory assistance 80 (34%), day services/out-patient care 38 (16%), residential services 44 (19%), accessibility to care 19 (8%), information/assessment 39 (17%), self-help and voluntary help 10 (4%), e-health 52 (22%), and discharge services 17 (7%). CONCLUSIONS: We found a large number of trials that investigated the effects of mental health services for people with SMI. Trials classification was difficult due to the poor report of the characteristics of these complex interventions. This database can be used to plan and prioritise systematic reviews according to the needs of stakeholders. RELEVANCE STATEMENT: The study is of interest to mental health nursing because it studies the different services in which nurses play a fundamental role with implications in the nursing practice, education, research or leadership and management.https://onlinelibrary.wiley.com/doi/10.1002/nop2.7010
Supporting a family member with dementia to live at home: The experiences of caregivers
Full text link© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).BACKGROUND: In the United Kingdom, specialist teams managing crises in dementia make efforts to reduce inpatient admissions by supporting people to live for longer in their own homes. However, fluctuations in the health and social circumstances of both the person with dementia and/or their family caregiver can lead to 'crisis': a breakdown in home care often leading to inpatient admissions. At this point, a team managing crises in dementia (TMCD) might become involved. These multidisciplinary teams begin with a rapid assessment to establish the needs of the person with dementia and their caregiver(s), followed by intensive but short-term interventions to reduce the risk of inpatient admission. There is little evidence as to how family caregiver experience input from a TMCD. METHODS: A thematic analysis of qualitative interviews with caregivers supporting a family member with dementia to live at home and who have received support from a TMCD. RESULTS: The personal troubles of family caregivers are intertwined with their experience of engaging with and trying to gain support from human services, particularly TMCDs. While respondents describe how specific individuals have addressed or added to the troubles they face, the most impactful interventions from their perspectives are medication for managing challenging behaviour and knowing that there is a service they can telephone in a crisis. CONCLUSIONS: Efforts to reduce inpatient admissions by supporting people to live in their own homes for as long as is practicable, even when carers may have reached the limits of their caring capacities, can, at best, only delay inpatient to long-stay residential accommodation. This is because when one frail older person has the responsibility of caring for another frail older person, even with support from TMCD and other health and social care services, crises are difficult to manage.https://www.mdpi.com/2227-9032/13/2/17